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Dr Louise Doherty Immunisation Conference 11th May 2016
Vaccine in the elderly In healthy adults aged less than 65 years the
vaccine efficacy of a well matched vaccine is 70%-90%.
Protective efficacy is lower in the elderly with an effectiveness estimated at 30-40% among the frail elderly
Vaccine is 50%–60% effective in preventing hospitalisation
80% effective in preventing death.
Season CHO
Number of Participating
Hospitals*
Number of Eligible Hospital HCWs
Number of Vaccinated
Hospital HCWs %
Vaccinated
2015-2016 1 3 2,848 427 15.0
2015-2016 2 4 5,816 795 13.7
2015-2016 3 6 3,939 637 16.2
2015-2016 4 5 6,640.82 975 14.7
2015-2016 5 6 6,298 802 12.7
2015-2016 6 5 4,367.56 1,567 35.9
2015-2016 7 6 11,143.14 3,540 31.8
2015-2016 8 5 5,158 869 16.8
2015-2016 9 8 11,836 3,990 33.7
2015-2016 Ireland 48 58,046.52 13,602 23.4
Staff Flu Vaccine Uptake by CHO Hospital
Staff Flu Vaccine Uptake in Saolta Hospitals
12.0%
18.5%
10.0%
17.0%
13.2% 13.5%
23.4%
0.0
5.0
10.0
15.0
20.0
25.0
Mayo General Hospital, Castlebar
Portiuncula Hospital,
Ballinasloe
Roscommon County Hospital
Sligo University Hospital
Letterkenny University Hospital
University College Hospital
Galway
ROI
Season CHO
Number of Participating
LTCFs*
Number of Eligible LTCF
HCWs
Number of Vaccinated LTCF HCWs
% Vaccinated
2015-2016 1 16 872 167 19.2
2015-2016 2 10 762 167 21.9
2015-2016 3 2 172 53 30.8
2015-2016 4 21 1,521.64 378 24.8
2015-2016 5 3 496 99 20.0
2015-2016 6 5 741 210 28.3
2015-2016 7 8 1,793 434 24.2
2015-2016 8 12 1062 230 21.7
2015-2016 9 10 1341 513 38.3
Staff Flu Vaccine Uptake in LTCF by CHO
HSE – Donegal Staff Flu Vaccine Uptake Seasonal Overview
166
251 269 238
91
270
346 365
257
521
615 603
0
100
200
300
400
500
600
700
2012/13 2013/14 2014/15 2015/16
LGH Community Total
“Nobody tells me what to do”
“It is a basic human right to decide for myself”
“If it is so important why isn’t it compulsory?”
The great enemy of the truth is very often not the lie…deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic. Belief in myths allows the comfort of opinion without the discomfort of thought
John F. Kennedy
10/9/2013 10
11
One serosurvey* showed 23% of HCW had serologic evidence of influenza virus infection during a single influenza season
…the majority had mild illness or subclinical infection
*Elder G, et al. BMJ. 1996;313:1241–2.
Kuster SP et al 2011. PLoS ONE 6(10):e26239. doi:10.1371/journal.pone.0026239
Influenza Vaccination Beliefs & Attitudes
Statement Ever Vaccinated
Never Vaccinated P value
I am healthy, I don’t need the ‘flu vaccine 19% 66% p<0.000
Getting the ‘flu vaccine is a good way to protect against catching ‘flu 64% 25% p<0.000
I have concerns about the side effects of the vaccine 35% 65% p<0.000
Due to the nature of my work I am at increased risk of getting ‘flu 81% 51% p<0.000
Getting the ‘flu vaccination not only protects you but also the elderly you care for 78% 52% p<0.000
I am at risk of catching the ‘flu 86% 66% p<0.000
The ‘flu vaccine causes the ‘flu 15% 26% p<0.000
My doctor does not recommend the ‘flu vaccine 6% 12% p<0.000
Make it attractive Convenient and comfortable (site and time) Incentives and rewards (raffles, spot prizes, chocolates) Inter-departmental/team competition – uptake by units published Identify key person on each unit/ward/team responsible for encouraging vaccination, vaccinating
Make it accessible Multiple opportunities (during day/night, week, month) Continuous programme October-March
Avoid “missed opportunities” offer immunisation during any contact
Bring vaccine to staff mobile teams, multiple sites, target group gatherings, team meetings
Throughout work day (and night)
14
15
Factor Vaccination rate in Programmes with
Vaccination rate in Programmmes without
Weekend provision of vaccine 58.8% 43.9%
Train-the-trainer programs 59.5% 46.5%
Report of vaccination rates to administrators 57.2% 48.1%
Letter sent to employees emphasizing the importance of vaccination 59.3% 47%
Any form of visible leadership support 57.9% 36.9%
Required declination 56.9% 55%
Talbot TR. Dellit TH. Hebden J. Sama D. Cuny J. Factors associated with increased healthcare worker influenza vaccination rates:
results from a national survey of university hospitals and medical centers. Infect Control Hosp Epidemiol. 31(5):456-62, 2010 May
YES ! Many studies have shown that increasing the vaccination rates of HCWs decreases patient illness and death.
One study showed a 40% reduction of influenza related deaths in hospitals with higher rates of HCP influenza vaccination.
Carman WF GD, et al. Lancet 2000;355:93–7.
16
What did we do?
Convened multidisciplinary group Meet all year round and plan campaign well in advance Have a graphic designer as part of group Engage with senior management and staff Recruited flu champions Teaser campaign Launch-with local footballers
What did we learn?
Senior management support is vital-small amount of funding makes a difference
Multidisciplinary team Flu champions (60 in community 0 in hospital) Leadership is important Key opinion leaders have a big role to play Bring dissenters on board and involve Needs to be someone’s job
Did we have any effect?
Started conversations Spread some other key messages about
influenza to staff and public Support from the public Won over local advocates Secured managerial commitment in community
Lessons Learned
The bad • The power of dissenters • Liaising with national campaign can be difficult • Capacity within Occupational Health can be limited • Difficulty in monitoring • Flu fatigue
The good Managerial support essential • Multidisciplinary team brings fresh ideas and skills • There are flu champions out there – use them • Long term, year long process needed • It’s ok to have some fun with it!
What are our plans?
Peer vaccinator programme Improved monitoring Feedback Better communication plan Building on momentum
So whose job is it?
It is the job of all staff to look after ourselves and the vulnerable patients we look after
Thanks Questions?
